颈动脉重建对头臂型大动脉炎的疗效分析  

Carotid artery reconstruction in patients with brachiocephalic Takayasu arteritis

作　　者：吕彦泽 李方达[1] 曾嵘[1] 刘志丽[1] 吴亮霖 郑月宏[1] Lyu Yanze;Li Fangda;Zeng Rong;Liu Zhili;Wu Lianglin;Zheng Yuehong(Department of Vascular Surgery,Chinese Academy of Medical Science,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院血管外科,北京100730

出　　处：《血管与腔内血管外科杂志》2022年第12期1411-1415,1426,共6页Journal of Vascular and Endovascular Surgery

基　　金：国家自然科学基金项目(51890894,82070492,82100519)。

摘　　要：目的 探讨颈动脉重建对头臂型大动脉炎(BCTA)的疗效。方法 收集中国医学科学院北京协和医院2015年10月至2016年5月收治的15例BCTA患者的临床资料。患者出院后定期进行门诊复查,检查支架及旁路血管通畅情况,术后3~6个月进行计算机断层扫描血管成像(CTA)或超声检查,观察患者的血管通畅情况、主要并发症发生情况及生活质量评分。结果 15例患者门诊评估均处于大动脉炎(TA)稳定期,受累弓上动脉共42处,最常见受累血管部位为颈动脉,重建动脉21处,所有患者手术成功率均为100%。随访27.4~36.9个月,平均32.8个月。术后第1、2、3、7天平均动脉压均低于术前,差异均有统计学意义(P<0.05)。术后,36条目健康调查简表(SF-36)总分以及各维度评分均高于术前,单侧手术患者术后生活质量改善程度高于双侧手术患者,差异均有统计学意义(P<0.05)。结论 颈动脉重建可缓解BCTA患者脑缺血症状,单侧病变患者生活质量改善程度高于双侧病变患者,脑高灌注综合征(CHS)发生率低于双侧病变患者。Objective To explore the effect of carotid artery reconstruction in patients with brachiocephalic Takayasu arteritis(BCTA). Method A total of 15 patients with BCTA admitted in Chinese Academy of Medical Science, Peking Union Medical College Hospital from October 2015 to May 2016 were selected. Out-patient revisit was performed regularly after discharge to examine the stent and bypass vascular patency, computer tomography angiography(CTA)or ultrasonography was conducted 3-6 months after surgery to examine the vascular patency, major complications and quality of life score. Result All 15 patients were in stable stage of Takayasu arteritis(TA) by out-patient evaluation,there were 42 arteries involved above the aortic arch, the most commonly involved vessels were carotid arteries, with 21 arteries reconstructed, the successful rate of 100% for surgery. The follow-up period was 27.4-36.9 months, average follow-up period was 32.8 months. The mean arterial pressure on the 1st, 2nd, 3rd and 7th day after operation were lower than that before operation, the differences were statistically significant(P<0.05). After operation, the total score of the medical outcomes study 36-item short from health survey(SF-36) and the scores of each dimension were higher than those before operation, and the improvement of life quality of patients with unilateral operation was higher than that of patients with bilateral operation, the difference was statistically significant(P<0.05). Conclusion Carotid artery reconstruction can alleviate the symptoms of BCTA cerebral ischemia. The improvement of life quality in patients with unilateral lesions is higher than that in patients with bilateral lesions. The incidence of cerebral hyperperfusion syndrome(CHS) in patients with unilateral lesions is lower than that in patients with bilateral lesions.

关 键 词：头臂型大动脉炎 血管重建 生活质量 

分 类 号：R543[医药卫生—心血管疾病]